Welcome to the Understanding Medical Billing course. I'm Alex Vaughn, I don't know if I'm going to be your torturer today or try to help you understand this better. But to give you a little bit of my background, I'm an oral facial pain specialist, which thankfully now is something we can actually claim and declare. And I'd say on the side, I'm a coding lay expert, is how I put myself. I'm certainly not a certified coder, but it is kind of the very basis to what we should be doing if we want to get paid well and run our business as well. So over the years, I've had to kind of learn how to do that, as well as on oral facial pain, we're getting into a little more tricky situations. So I've certainly had to learn by failure, which is probably the best way to learn. I'll tell you too, on these slides, nothing is absolute, but you'll see the little disclaimer unless it is, there'll be a few times that we really do have absolutes, but for the most part in coding, it is a little more variable. And sometimes we have correct ways to do things, and sometimes we have better ways to do things. So I'll try and kind of split those out, but welcome to the journey and we'll get started. So the goal for this course is that we're going to review how medical insurance actually works or how it's supposed to work, when things are working correctly, and the insurances aren't just creating problems, as well as how to interpret different medical policies, review diagnosis coding, review procedure coding, and then practice coding a patient together, hopefully. Starting with insurance, there are three main phases. So I want you to think about medical insurance more as three separate companies you're dealing with rather than one insurance company. You're not really dealing with just Anthem, you're dealing with three different branches of Anthem, and each of them have their own rules, their own problems, and their own ways to slow down the process. So these are the steps you'll go through with every single patient. Sometimes this can be done through software, sometimes this requires a phone number, but each step is something that has its own process and its own rules, and they are different than each other, and they don't necessarily apply to each other. So I'll try and highlight those as we go along, but I want you to think of each step of the patient from beginning to end as each of these steps together. So as far as the first step, we're looking at eligibility. This is simply looking to see, can a patient receive care and have it paid for by their insurance? The next step is going to be medical necessity, is what we're doing necessary for insurance to cover, or is it something that's a choice of the patients, or something that the insurance feels is experimental? And then the last step, which is both the most important step for us as a business, but also for the patient, is payment. We need to make sure that we've got every step done along the front end so that we get paid on the back end, and we aren't left either trying to hunt down the patient for the funds that we didn't expect to come in, or left holding the bag and simply not having payment for that claim. So which stage you're in is going to determine what your answers are to problems. Realistically, insurance is not perfect. They are going to make mistakes, but also they're going to design mistakes along the way to slow down payment or deny payment, just seeing, okay, are you going to appeal? Are you going to fight for your payment? Or can they simply say no, and you walk away and they get to take the write-off, or not even a write-off, they get to save themselves money. So as far as what you can do in each stage, sometimes you can appeal. We also have reprocessing, reconsideration, and appeals separately. Peer-to-peers, it's all a different process. So as far as appealing, this is usually the last stage, but I want to start here because it's the most important stage for your patient. Patients have appeal rights in their insurance. Every state has different laws, how those are determined. But in general, a patient is going to get one or maybe two appeals, and you can actually take away their appeal rights by appealing for them. So you need to make sure you're doing it at the right time. But in general, patients will prefer you do the appeals. But also on your appeal, you need to make sure you have the right goal. And again, this is where the stage matters. So if you're appealing an eligibility decision, your goal should not be to fight the insurance and say that a sleep appliance is appropriate in their case because they have mild apnea. The insurance has said they aren't eligible because they didn't pay their premiums. So whether or not your treatment is necessary does not matter if the insurance is saying they didn't pay their premium this month. So don't waste your time fighting a fight that you're not going to get through. So have the goal for the appeal in mind. And then again, remember your patient's rights in that appeal. Generally speaking, again, nothing is absolute, but generally speaking, you will not be able to take away all of their appeal rights without a signed document from the patient. So most insurances, even when you're in network, are going to make you have the patient sign the final appeal so that they can't then come back and claim, well, I never appealed. When we're looking at reprocessing or reconsideration or appeal, these are three different terms insurances will use. They are not interchangeable. They are different stages. So reprocess of a claim is simply asking the insurance to relook at it, everything you sent and basically run it through the computer again. It's not the most common thing to have a reprocessing actually end up in your favor. Normally, it's kind of like if you think back to school with the multiple choice answers, it's kind of just reprocessing your answers. Generally speaking, you're not going to get a different outcome, but it's usually the first step, especially if insurance made a blatant error, like had the patient's name wrong or said that the patient doesn't have benefits when you know they do and you had confirmed eligibility first. So sometimes it's just a simple, they read the claim wrong and you ask them to reprocess and they may catch it. A reconsideration, on the other hand, is asking them to apply some thought, but not much to it. So they may make a determination that the patient is not eligible for benefit because they haven't paid their premiums if we're in the eligibility stage, but the patient shows you a receipt that shows they paid them or the patient declares or promises they had. You can sometimes ask for reconsideration and say, can you guys double check that? And then an appeal is a much more formal process and that process, you're submitting essentially your evidence. The insurance is then going to have a human review your evidence, review their policy and actually apply a little thought to it. Appeals most of the time will succeed. That's the amazing thing is insurances will deny claims simply to see, will you appeal? It's very rare that I don't get an appeal through that we didn't actually expect to fail. In other words, unless I'm going against a policy that I know is a little adventurous, let's say, usually appeals will work if I knew I had my ducks in a row to start. The peer-to-peer process is a very, again, unique process and different for each insurance. But generally speaking, if we divide decisions that insurances make into two categories, one is going to be a contractual denial and one is going to be a medical necessity denial. So contractual denial just simply states patient isn't entitled to this benefit most of the time. Good example is there's some states where Medicaid does not cover sleep appliances at all and E0486 is an excluded code. So in those cases, that'll be a contractual denial where the insurance says they aren't eligible for that care in any way, shape or form. For those you often can't do a peer-to-peer because there's no physician reviewing anything. It was cut off before then, whereas a medical necessity denial must be determined by a physician in almost every state. I want to say probably every state, but again, nothing is absolute. But generally speaking, a denial due to medical need needs a medical provider to make that decision. So in those cases, you can request a peer-to-peer, typically before the appeal stage. And what this is going to do is it's going to get you in touch with the doctor on the other end or one of those doctor's colleagues that made that determination where you can argue your case. So for an example, we had a patient last week where we were told that they weren't eligible for care or that they weren't eligible for the sleep appliance because they didn't have a comorbidity with mild apnea. We knew in our note, it was the very second line of the note in the sleep physician note it's bolded because our sleep physicians know also what the coverage care guidelines are. So we knew it was in the documentation we sent and they just didn't read it. So we chose to skip the reprocessing stage. We knew that wasn't going to get us anywhere. The reconsideration stage may have, but we jumped right to peer-to-peer and did a peer-to-peer call. Typically they'll set up a time within a few days and you speak with them and discuss it. And on that call, we simply highlighted, Hey, it says right here what the comorbidities are and the reviewer on the other end, because remember you're talking to a doctor at this point. Prior to this, it's rare that a doctor has really looked at it hard. So usually those other healthcare providers do have a heart for the patient. So as long as you're making a reasonable argument, oftentimes you'll get through, unless you're making something either completely unreasonable or the policy is written in a way that really does require that. They do still follow policy, but peer-to-peers are not as frustrating as I think sometimes we worry about them being. And again, processing this is a process. It's one step at a time. And sometimes you have to go through each step and appeal or reprocess phase. It's rare that you do, but just remember just because you've gotten through one doesn't mean the next stages are guaranteed to go through. As far as eligibility again, now let's kind of get into specifics. So on eligibility, you're looking at, is the patient eligible on the date of service? So the day that you're actually going to render care. So if you see them, if I'm going to see a patient, let's say October 30th, if I'm calling in September, I need to be very specific when I say, is the patient eligible for coverage on October 30th for this, this appliance? Most of the time, the interns will ask you to give them a date of service, but occasionally they won't. Then you're looking to see, is it a covered service and is it a covered service for this diagnosis? And that's especially important in sleep because many insurances will cover the sleep appliance for sleep apnea, but not for snoring. So again, you're going to want to verify, okay, is E0486, which is your service code covered for the diagnosis of sleep apnea? And we'll go over to the coding in a little bit, but you'll want to make sure they know both. Again, oftentimes they'll ask both, but there are plenty of times that they don't. We have fought these claims before where the insurance said E0486 was covered, and then we later got the claim denied and they said, well, it wasn't covered for that diagnosis. So we appealed it, stating we had asked for coverage, had a copy of the phone call and one because the insurance did not specify the diagnosis, that is their responsibility. But having all those records in place is not something we necessarily always have. A benefits check, you're basically looking to see what portion of that will the insurance cover? What is their deductible remaining? How much, what is their catastrophic cap or their maximum out of pocket payment? So then the benefits check, you're going to ask, you know, what deductible is remaining? What do they have in network or out of network benefits? What percentage is the coinsurance? All these things I'll go into, but these are what we're checking at that stage. The last two things are insurance card, make sure you have a copy of the patient's card on file. Many insurances will list that as a requirement to have the claim paid is that you have a copy of the card readily available. They don't ask for it, but if they'll deny it, they can ask, do you have it on file? And if you can't present it, then they can deny it. And then insurance disclaimers, you're always going to get a disclaimer that, that confirmation of eligibility is not confirmation or guarantee of payment. And all that is saying, that doesn't mean the insurance isn't, they're not trying to trick you. All they're saying is that at the eligibility stage, they're not looking at, was it necessary? So they're going to verify, yes, the patient is eligible for care, but they can certainly deny it for other reasons. And again, that's why each step is its own step. And you get through that, you go on to the next one. Financial necessity, also known as utilization management. This is most likely the most frustrating part of insurance, but I will be honest, I think it's the most important. At the end of the day, what does keep our insurance costs, relatively speaking, under control are these utilization management protocols. The idea is you shouldn't necessarily need to access your doctor for every reason under the sun. You should actually have to have a need for that. In other words, there's no reason that insurance should cover a sleep appliance on someone that doesn't have a sleep issue. They don't snore, they don't have any apnea. Why should they cover an oral appliance? So we want to save costs to keep the overall cost low. But every insurance is going to have their own policy. They're specific to that insurance and often to that insurance in that state. So you'll need to, I would recommend finding these policies and I'll show you how to do that. You're also looking at on and off label care. So most policies are going to have a disclaimer that states this is only for on label use. So in sleep, this is especially important for appliances that are not FDA cleared. If it isn't FDA cleared, it's not on label use or it's not FDA cleared for that use. It's not on label use. So a good example would be a mandibular repositioning splint. Well that does keep the lower jaw forward. Of course it's not like a general sleep appliance where we're going to have a force holding the arches together. Not as long as the patient's teeth are together, that will protrude the mandible, but that is not its labeled indication. The FDA has not approved it for use in treatment of sleep apnea. And so in those cases that's off label use and the policy will not apply. All insurances will have an off label use policy, which I'm not going to get into, but just know that on and off label does matter. In versus out of network matters as well. So a lot of insurance policies will, not necessarily in the policy state that is covered for in network or out of network benefits, but your access to the policy can change. So for example, in some of our insurances, only in network providers have online access to the policy, their utilization management policies. Every state has different laws. In Virginia, our law states that all insurances must allow providers a phone number to call into to receive policy guidance. So it does not require that they publish them online. So again, every state is different. That's where it gets difficult to kind of write a generalization, but just know that you can have different rules for in versus out of network, but what can't change on the rules is the medical necessity itself. So what insurance can't say is it's medically necessary for a patient to receive it from an in network provider versus an out of network provider. Again, the network side is more on the eligibility and benefits side than it is utilization management. So if you have some insurance that tells you, well, we won't evaluate your request for coverage because you're out of network, respond to them that you're looking for a utilization or medical necessity determination, because most likely it's the wrong department that they put it through. The last couple of blocks here are generally accepted. So the idea is if there's a general acceptance of this as medically necessary, a lot of times they will not have a specific policy on this. So for example, splints, not oral splints, but maybe a cast or a splint for broken finger or wrist or sprain or strain, generally speaking, that's going to be considered medically necessary and they're going to have a specific policy about it. So if it's generally accepted treatment that you ask 20 people, you're going to get the same answer, assume that there probably will not be a policy. And the last thing is exception to policy. There's always an exception to policy and that is an absolute. Now, the exception might not be easy to get, but no policy on the planet is absolute. So, for example, AIM typically is a utilization management company for Anthem, and they have a policy that you have to follow CMS criteria for your appliance. Up until recently, and I know this is in this lecture, so I might be wrong, but up until recently, Medicare had not approved an appliance that was metal-free. They now have one, I believe, that's metal-free that has been approved, but we've gotten plenty of appliances through on exception to policy on that regard, because the patient has a metal allergy. So, just because the policy is written in stone does not mean there aren't exceptions. Now, getting that exception is also a process. Generally, you're going to have to appeal, do a peer-to-peer, explain your case. I've had plenty of times on peer-to-peers with these metal-free arguments that the insurance has said, well, I need a physician to verify that that's in a metal allergy. Know your ground and stand your ground. The response is, no, you don't. I'm licensed to evaluate conditions of the mouth, and the patient has an allergy to metal. If you know what your license allows you to do, you can usually explain that to the insurance companies and get your exceptions, but please don't understand that to mean that you can get an exception for any reason, no matter how flimsy it is. If there's no good, good medical need, just follow the policy. An exception to policy is rare when there's no medical need, and you can't explain it in a good fashion. So, I often get asked questions about which policy says what and how to really just know what the insurance says, and as I said earlier, finding the policy and knowing your policy is key to getting insurance to cover your appliance, both for you and your patient. One of my favorite sayings from working IT in the past was that, you know, your IT person isn't necessarily better with computers than you are, they're just better at Google than you are. So, I want to take a moment to kind of show you really how to find these for two reasons. One, they change every year. So, I can give you the policy today, but it might be different tomorrow. So, always going through and checking these is important, but two, I don't know every insurance in every area, and so it's kind of nice to be able to look in your own area. So, for an example, let's go to Google here. I'm in an incognito window so that we make sure that, you know, Google certainly knows what we search for. This way, it's not going to know my history, so hopefully it's not going to help me at all in finding these. So, I can kind of come at it from the same perspective everyone else will, but it's this easy. Type in the insurance you want, Cigna, policy. If you want, you can type in utilization management policy or medical policy, but most of the time policy is fine, and then what you're looking for. So, you can either type in oral appliance therapy or I like to first start with just E0486. Most policies are going to have written right in the policy what codes it applies to, so usually you can search for that. So, let's search. Ignore, of course, the ad at the top, and we'll see right here two different things. I don't know what this one says yet. Maybe we'll look at future coverage positions. This might be what they're changing to, but this first one here, very first hit, obstructive sleep apnea treatment services, Cigna for HCP. It's Cigna for healthcare provider. That's their main website for doctors to go to, so let's open that up, and in here you'll see two things I want you to look at. One is what the effective date is, so this is effective June 15, 2019, and it's going to be reviewed June 15, 2020. Now, today is at the end of July, so it's obviously a little different date and past that date, but given COVID and they aren't required annually to necessarily change these, as long as the effective date is in reason and the review date is reasonably close to your current date or in the future, you can assume that's the active one, and you'll see here they've kind of got a related covered resources, so if you want to jump to a different, you know, let's say you want to look at, okay, how do we get sleep testing covered for our patients if we're going to refer off? What can we do for our physicians to help them out? You know, I've got those there, but the best thing to do is search, so you can do that. Hold down your control key and press F for find, type in E0486, and it's going to go right to the sections. Now, sometimes, again, some policies will call it out right in there, like this one does where it says HCPCS codes E0485 and E0486, but if I search for E0486 and that doesn't come up, usually then I just search for oral. There might be 100 of them, you know, and this time it looks like there's 89. You can try oral appliance. Sometimes that limits it down more, but searching through is always kind of the easiest way, and then make sure you read these carefully. Insurance likes to hide things in here for sure. Obviously, just the general disclaimer, is it covered or is it not covered, and to look for the plan documents to see. So, you'll want to go through there, but, you know, assuming it is and you've already done your benefits check to see that they're eligible for it, you're going to go through here, and now we're going to look. So, these are the requirements, and you'll see it's considered medically necessary, meaning that they will approve it for an individual with mild or moderate OSA. So, again, mild or moderate, so no severe with Cigna initially, and then when either of the following criteria, you're going to see some plans say either, some say and, some say and or, so just make sure you're reading there. So, what do they need? HI, RDI, REI of greater than 15, less than 30, right, so moderate on a PSG or sleep apnea test. So, that's kind of the same as Medicare, right, or an HI, RDI, or REI. Please note these are all ORs, so whatever your sleep study reports is fine. Choose whichever one you want to present. So, between 5 and 15 is documented on PSG or HSAT with symptoms of OSA, and then they give example symptoms, or when the patient has hypertension, ischemic heart disease, or history of stroke. So, right there, you've got an approval. All right, and that may be not an approval, but you know it meets medical necessity. So, let's keep going down, see if they have anything on severe patients. So, here we go, tongue retaining device or mandibular repositioning appliance is considered medically necessary for an individual with severe OSA who is unwilling or unable to comply with PAP treatment. So, in this one, in this policy, all they need to be is unwilling. They don't actually have to undergo it. A lot of policies do require that they undergo PAP and fail it. Some will even define what a PAP trial is or an adequate one is, and they'll say it's 90 days with 50 percent compliance. So, just read through the policies, and just remember every policy is, in essence, the guarantee or almost automatic acceptance. Now, you still have to go through their steps to do your pre-auth, but if your documentation is in line and you highlight that on your pre-auth process, it's almost guaranteed to be accepted. It is not the absolute, though. So, certainly, if we have a patient, let's say this didn't say unwilling, but required that they go and undergo PAP treatment, but the patient has severe PTSD and they have, you know, episodes when they wear their PAP mask, and that's documented by their psychiatrist and their sleep doctor. Well, in those cases, even if it requires a failed PAP trial and it defines that as, you know, wearing it for 90 days and whatnot, you can usually get an exception to that policy. It's just in your pre-auth, you have to specify that. So, go in already. Don't try and sneak something past insurance. Just go in and say in your pre-auth or in a letter of medical necessity, and especially if you have the physician notes, say, you know, sickness policy. This isn't a great example. Let's say an anthem policy says that. Let's say we found one. So, Anthem of Nevada, Blue Cross, Blue Shield of Nevada policy is that the patient must undergo a PAP trial of 90 days. However, there's an absolute contraindication in this patient due to the history of PTSD and the fact that utilizing a CPAP or the CPAP mask brings on episodes that are not allowing the patient to sleep, as documented by their sleep physician and their psychiatrist on XYZ date. Please see in closed doctor's notes. So, if you're asking for an exception, telling the insurance their policy, showing them that you know their policy, showing them that you're asking for an exception, I have found gets you an approval much faster than trying to just sneak it by them, hope they don't notice, and then if they do, have to do your peer-to-peer and go through those steps. As odd as this sounds, insurance really, in general, is our friend and does support our treatment. They just do it with their rules, and you just have to follow their rules, which also means knowing when you step over the line and going into an exception to their rules. So, it's a little bit of everything here. The other thing I'd like to highlight on here, follow-up sleep testing to improve or confirm oral appliance efficacy and follow-up with their qualified healthcare professional for donor-related side effects. It's considered medical necessary, so that means that the follow-up study will be covered as well as replacement when the item's reached the end of its five-year reasonable lifetime use or when wear and tear renders the item non-functioning, and that is no longer under warranty as medically necessary for repair. So, lots of good things in this policy, and as long as you know it, like I said, I'd print these off, have them ready to reference whenever you need them, and you should be good to go. So, payment, the most important stage that we have to get through probably. We're looking at, A, is the patient going to have to owe what or how much the patient going to have to owe, and how are you going to get your checks, and when are you going to get your checks? So, with payment, the very first thing is assignment. Now, this is very similar to dental benefits where you can either accept assignment. In other words, you are submitting the claim for the patient, and you're telling the insurance, send me the check, and I will take your write-offs in general is what accept assignment means. You can certainly accept assignment and balance bill if you're out of network with some insurances. Now, that's questionable in the COVID era as well, so I'd encourage you to, if you want to do out-of-network billing, accepting assignment may be something you want to defer on. It's certainly the safer option, and then, in versus out-of-network benefits, you're simply looking at, have you signed a contract with the insurance company agreeing to take their write-offs, and in return, the insurance company is going to, in theory, work with you easier, and you're going to get a better benefit for your patient. So, most insurances are going to have a different in versus out-of-network percentage that the patient owes as well as nowadays a different in-and-out-of-network deductible and a different in-and-out-of-network out-of-pocket cap. So, it's very important to view those things. Now, the other difference between in-and-out-of-network is you can be in a limited in-network status, otherwise known as a gap exception or network deficiency exception or whatever your insurance wants to call it, but what that is is you're an out-of-network provider. You do not have a contract with your insurance company or the patient's insurance company, but you can contact the insurance and say, there are no providers for this patient in the area, and I'm willing to work with the patient. I'm willing to work with you as the insurance company. Will you please provide in-network benefits for this patient? Generally speaking, what the insurance is going to do is look to see, okay, are there any other providers with your credentials or that can treat this patient? And that's an important distinction because most insurances do not recognize dental specialties really of any sort other than oral surgery versus dentist or general dentist or endodontist or periodontist. Really, they look at it, are you an oral surgeon or are you any other type of dentist? So there are plenty of times that I've asked for a gap that the insurance has come back and said, no, there's a dentist right there that can do it. Usually then I'll have the patient write a letter or I'll write another letter explaining the difference between someone who's trained in dental sleep medicine and just a general dentist that has no training. The other times we'll run into it is when an insurance company only contracts with oral surgeons, they'll often tell you, well, there's an oral surgeon in-network here that can can see the patient. That's a tough spot to put to be put in. The best answer to that is call the oral surgery office yourself and ask, do you do oral sleep appliances? If they say no, go back to the insurance and say that office does not provide that benefit. At that point, the insurance is supposed to give you proof that they called and received a yes answer to that question. So most of the time they can't, and then they'll give you the gap exception. So there are times that you can get an in-network benefit for your patients without having to sign the contract. The other difference here is that in a gap exception, again, which I use synonymously with the term network exception or network deficiency, every insurance is going to do something different, but a gap versus a single case agreement. Now in a single case agreement, you have contacted the insurance and you have a guaranteed price written down on paper signed by you and the insurance company, and it puts you in contract or in-network just for that case. But because you've negotiated your fee, it's a lot easier to estimate for your patient, and you can often negotiate a better fee than if you don't do that. So I encourage you, anytime you ask for a gap exception, once approved, ask for a single case agreement. You don't have to sign them. So if during a negotiating stage you go, listen, I don't like that price, you can just walk away and still bill in-network with your gap. Now the patient, then you have to decide you want to balance bill the patient. That's a whole nother discussion about that, which I don't really want to go into right now just because it's certainly heated and difficult to determine and something that you determine on your own. As far as deductibles, these I want you to think of as just like on dental insurance deductible, the only difference is it's much higher and it's different for every patient and within each insurance. So it's not an Anthem deductible, it's which plan in Anthem does the patient have. Get on your benefits check, you'll get this answer, you should be asking for this. But most plans, the insurance has to pay their full deductible before the plan pays a penny. That might differ for your exam, but not always. So some insurance plans ask the patient to pay for the full exam cost if they've not met their deductible. Other insurances will allow the co-pay for the exam to prevail. So it is specific, you can certainly ask the insurance during the benefits check. Co-insurance versus co-pay. Co-insurance means that the insurance is going to pay a portion, the patient is going to pay a portion, and it's percentage based. So this might be, for example, the most common is an 80-20 split, where the insurance pays 80% of the cost, the patient pays 20%. And this is what fee, as far as cost, is what the insurance determines is the appropriate cost, not your fee. So this is also called the limiting charge or the allowable. That's what the insurance is going to calculate their co-insurance off of. The co-pay, on the other hand, is it just a straight predefined dollar amount, typically for the exams. You'll often see on the patient's cards a specialist exam $40 co-pay. In that case, the patient just pays you $40, the insurance pays the rest. Some insurances have co-pays for DME or E0486, some have co-insurance, most are co-insurance, but again, that is something you can ask during benefits check. Last steps of payment. They need to pay you, but they need to track it. So the insurance will need a W-9 on file. Don't be surprised if they ask you to send in a W-9 if you've not sent them one before. This is simply the same W-9 you send to all of the insurances you work with or any other time someone asks for a W-9. It's what allows the insurance to track their payment to you so they can report to the IRS. You don't need to worry about sending that as them trying to trick you or anything. It's just normal. And then check versus EFT. Some insurances will cut you a check. Some you can register to get the funds transferred to you directly, very similar to dental insurance. And the last is the ERA. This is an electronic remittance advance or is one way they can term it. The big idea with that is you're going to get, it's your EOB, if you will. It's a different term for EOB. It's what you'll see on the medical side. But it's basically just them telling you, here's what we're going to pay you. Or I'm sorry, and it's not an advance. I apologize. It's an electronic remittance advice. It's what they are covering.

medical insurance

coverage guidelines

appeal process

benefits check

specific codes

in-network

electronic remittance advice